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The Multi-Vitamin Fallacy

As a culture of unhealthy people, we are very concerned about our diet. Not just for the calories, but also for the nutritional content. I personally know many fitness junkies who will swear by the supplementation of this nutrition, through the use of multi-vitamins. However, as we will see below, the multi-vitamin fallacy has gone on long enough.

The average American eater gains more than enough nutrition and vitamins from only their daily diet, and supplements are not required. What this implies then, is that the average consumer (excluding the legitimately malnourished or deprived) does not need to purchase expensive multi-vitamins (MV’s) that are 1) unnecessary, and 2) unregulated for safety. This MV fallacy then lands in the murky realm of pseudoscience with unsubstantiated claims about your health. But first, what are the facts?

The Data

The basis for the claim that MV’s are unnecessary is based upon two new large studies.

“The multivitamin as insurance policy is an old wives’ tale, and we need to debunk it” –Miriam Nelson, PhD, director of the John Hancock Research Center on Physical Activity, Nutrition, and Obesity at Tufts University.

The first study was a review of 63 randomized, controlled trials on MV’s, published by the Agency for Healthcare Research and Quality, found that MV’s did nothing to prevent cancer or heart disease in most populations (the exception being developing countries where nutritional deficiencies are widespread). In the second study, published last year, scientists at the Fred Hutchinson Cancer Research Center followed 160,000 postmenopausal women for about 10 years. The researchers’ conclusion:

“Multivitamins failed to prevent cancer, heart disease, and all causes of death for all women. Whether the women were healthy eaters or ate very few fruits and vegetables, the results were the same,” says the lead author, Marian Neuhouser, PhD.

The fact is that your body is evolutionarily adapted to make very good use out of the food that you eat. It takes much less food, and types of food, to fulfill you body’s nutritional requirements than you may think. In reference to the study above, because the women who were taking MV’s were both following a “healthy diet” and a not-so-healthy diet, and the causes of death were unaffected by MV use, the MV is ruled out of being a significant contributor to death prevention (and overall health).

But maybe you don’t expect a MV to pull stave off the grim reaper, more so just make you a “healthier” person. Perhaps MV’s can boost immunity or energy, as many purveyors of untested “supplements” often claim (with no evidence). But as you may expect from the content of this post, the results on MV’s with respect to immunity and energy are also negative. A British review of eight studies found no evidence that MV’s reduced infections in older adults. Another study found that the vitamins didn’t improve fatigue among breast cancer patients undergoing radiation therapy. And inner-city schoolchildren who took a multi did not perform any better on tests or have fewer sick days than students who didn’t take one.

“There is even a small body of evidence that may suggest harm from a multi [vitamin],” says David Katz, MD, MPH, director of the Prevention Research Center at Yale University School of Medicine.

And the evidence keeps piling up. A 2010 study of Swedish women found that those who took multivitamins were 19% more likely to be diagnosed with breast cancer over a 10-year period than those who didn’t. A 2007 paper in the Journal of the National Cancer Institute found that men who took multivitamins along with other supplements were at increased risk of prostate cancer. And other research has linked excessive folic acid intake to higher colon cancer risk in people who are predisposed.

“In terms of a risk-benefit ratio,” says Dr. Katz, “why would you accept even a tiny risk if you’re not getting any benefit?”

Another danger is the bio-accumulation of unused vitamins. If your body is not using these supplements, some of them may begin to accumulate in your tissue. With enough use, the benefit of these vitamins is outweighed by their potential toxicity.

Buyer Beware

Unfortunately, the FDA lacks the proper teeth to regulate these “supplements”, including vitamins, minerals, and herbs, the same way it does for drugs. There is a critical loophole that supplement producers take advantage off, in the same way that homeopaths do. If you call your product a “supplement” and not a drug intended to have clinical applications, you basically have a free rein. Supplements don’t have to go through any safety or efficacy testing before they hit store shelves. Despite 2007 legislation that marginally increased the FDA’s authority, the FDA still doesn’t have enough resources to oversee the industry. An industry, mind you, that has opened its doors to the charlatans of pseudoscience. Because supplements lack regulation and testing, a supplement that claims to reduce heart attack risk is accountable only to the public. And the public, in the realm of awareness and skepticism, is horribly lacking (homeopathy, balance bracelets, acupuncture, etc.). Until the FDA can garner more support and muscle, the health care and supplement aisles of your local Wal-greens are rife with nonsense.

Protect yourself: Choose products with seals from quality-testing companies like United States Pharmacopeia (USP) or NSF. Supplement companies pay to have their products evaluated according to these more rigorous protocols, which check for contaminants and ensure products contain exactly what their labels say.

You can also subscribe to ConsumerLab.com, an independent testing organization, for reports on specific supplement groups, like omega-3s. Finally, don’t take any supplements without talking with your doctor. Many interact with medications or can worsen health conditions.

A Change of Habit

So if the evidence is fairly one-sided against daily MV intake, why has the common knowledge professed to taking them? Was previous research wrong? One a word, yes. One reason is that previous researchers were studying the wrong people. It’s now well-known that people who take vitamins tend to be some of the planet’s healthiest to begin with. Researchers have shown that vitamin takers tend to be leaner, more affluent, and more educated. They drink and smoke less; they exercise and go to the doctor more. In other words, they’re healthy despite their use of MV’s, and researchers were confusing their cultivated healthy qualities with the effects purely of MV supplementation.

In addition, the very concept of a MV as a nutrient delivery system is limited. We now have a much better understanding of how well whole foods deliver their nutritional benefits. A typical multi contains 10 to 25 isolated nutrients, but fruits and vegetables have hundreds of active compounds with a long list of health properties.

“The vitamin C in a multivitamin is likely just not as effective as the vitamin C in a citrus fruit, where it’s also surrounded by fiber and flavonoids and carotenoids. All these nutrients working together is what really keeps you healthy,” explains Dr. Neuhouser.

So even when you’re not eating the healthiest diet, there’s no proof that a multivitamin is the right tool to fill in the gaps. Don’t you take enough pills already?

‘And it doesn’t make up for the main disease-fighting nutrients the average American is missing, like fiber, omega-3s, and vitamin D,’ says Dr. Katz.

Since these studies, all of the above doctors have stopped taking and recommending MV’s to their patients. But lest that sounds like an argument from authority, the science tells us that there is really no efficacy for (certain) MV’s for the average American eater. Money that you are spending on “herbal supplements” or the like may now be spent elsewhere on products or drugs that actually work.

Unfortunately, according to a new survey done by the CDC, the use of multivitamins have crept up to nearly 40 percent.

The survey found that most people who take vitamins and other supplements are educated, have good incomes, eat pretty well and already get the nutrients they need from their diets, the surveys suggests.

“It’s almost like the people who are taking them aren’t the people who need them,” said Regan Bailey, a nutritional epidemiologist with the National Institutes of Health.

Whenever you venture off the path of scientific testing and efficacy, you are bound to hit obstacles. And product efficacy and knowledge is especially important when it comes to your health. In the case of the MV, you can stop hounding yourself after a workout about your intake of riboflavin or B-12. You get this from a normal diet, even a somewhat unhealthy one, and you should not seek relief from health problems in aisles of these untested, unregulated, “supplements”.

UPDATE

Researchers at National Sun Yat-Sen University in Taiwan have found that taking a multi-vitamin makes people feel invulnerable to the health consequences of other choices.

In the new study, the researchers randomly assigned adults to take either a pill labeled “multi vitamin” or a pill that was openly acknowledged to be a placebo (both were actually placebos). Then they tracked participants’ preferences and behaviors across two health domains — eating and exercising. Participants who thought they had taken a vitamin were less likely to pursue the healthier choice: they were more likely to choose an indulgent buffet over a healthy, organic meal, and they were less interested in, and spent less time, exercising.

What’s going on is a clear case of “licensing.” Licensing refers to a common trick of the mind first identified by Princeton psychologists studying prejudice and discrimination. When we do one thing that earns us “credits” (e.g. rejecting an obviously sexist or racist statement to earn “moral credentials,” or taking a multivitamin to earn health points), we feel liberated to pursue the opposite goal. So a human resources officer who recently hired a minority or a woman may feel licensed to ignore concerns about diversity or fairness in the next hiring decision, and – as we see in this new study – people who take a vitamin feel licensed to skip the gym and hit the buffet line.

UPDATE 2

A new review of popular multivitamins found that one in three did not contain the amount of nutrients claimed in their labels or improperly listed ingredients.

After testing 38 multivitamins for a new report published online this week, researchers at ConsumerLab.com discovered that eight contained too little of specific nutrients, two contained more nutrient than claimed and three improperly listed ingredients.

“We found a wide range in the quality of multivitamins,” said Dr. Tod Cooperman, president of the company. “Interestingly, the more expensive products didn’t fare any better than those that are just a few cents a day.”

While medications are closely overseen by the federal Food and Drug Administration, supplements like vitamins don’t get regular testing by any government agency. So there’s no way of knowing — outside of independent testing — whether a bottle of supplements contains what it’s supposed to.

Although low levels of certain nutrients can be a problem, doses that exceed recommendations are especially worrisome. Several products evaluated by ConsumerLab, including some designed for children, had this issue.

ConsumerLab is a Westchester, N.Y., company that independently evaluates hundreds of health and nutrition products and periodically publishes reviews. For this test, ConsumerLab purchased a selection of multivitamins and sent them, without labels to a lab for testing. If a problem was found, the product was sent to a second lab for confirmation.

Particularly worrisome were high levels of certain nutrients in some of the children’s multivitamins. For example, Hero Nutritionals Yummi Bears, if given to children at the suggested dose, would exceed recommendations for Vitamin A in youngsters aged 1 to 3. Higher levels of the nutrient in kids have been linked to liver abnormalities, bone weakening, and problems with the nervous system, Cooperman noted.

ConsumerLab found almost no connection between price and quality. Many of the cheaper pills (prices ranging between $0.03 and $0.14 per day) passed all the tests, while some of the most expensive ones (priced as high as $1 per day) failed.

“People are using these products more and more,” Cirigliano explained. “There needs to be more regulation.”

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11 thoughts on “The Multi-Vitamin Fallacy”

I can really relate to this with my mom being a sales rep for Advocare, one of the biggest companies in the supplement industry. I’ve always been suspicious of these kinds of products myself and found it hard to justify my position, which just got a lot easier. Keep up the good work!

I haven’t been able to take MVs for years. The vast majority have calcium, and any time I get excess calcium, it hits my kidneys. Let me tell you, those calcium-based stones HURT. The biggest one so far was the size of a green pea and they had to surgically remove it. It was the result of taking prenatal vitamins when I was pregnant. Once I stopped taking MVs, most of the stones went away. I still get them occasionally if I get too much calcium in my diet from food over a prolonged period, but never as bad as the concentrated amounts I was getting from the MVs.

You are then the perfect example for the dangers of MV’s. You get all the nutrients that you need from your normal diet, the rest of the supplemented nutrients bio-accumulate until they become toxic, or in your case, painful ramifications present themselves.

The greater danger is that we have a psychological tendency to overestimate value. If a certain amount of a vitamin is good, then double or triple that amount is better. But this is not how the body functions. I admit it’s hard to grasp how such tiny amounts of vitamins and minerals ingested in our food can sustain us, but sometimes that’s how science works. We have to leave behind our intuitions for the evidence.

This can be summed up in one sentence: If you eat a wide range of nutritious foods, you don’t need to take vitamins; if you don’t eat a wide range of nutritous foods, taking viatmins won’t make up for it.

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About the Author

Kyle Hill is a science writer and communicator who specializes in finding the secret science in your favorite fandom. His work has appeared in Wired, The Boston Globe, Scientific American, Popular Science, Discover Magazine, and more. He is a TV correspondent for Al Jazeera America's science and technology show TechKnow.